GREAT LAKES ORAL AND MAXILLOFACIAL SURGERY P.C. (NPI# 1760008528) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760008528 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES ORAL AND MAXILLOFACIAL SURGERY P.C. |
| Practice Address |
2325 Summit Park Dr Ste D Petoskey MI 49770-8774 |
| Practice Telephone | 2314871020 |
| Mailing Telephone | 2314871020 |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |
| Authorized Official Name | DR. ROBERT SCOTT SHEPERD (CEO/PRESIDENT) |
| Authorized Official Telephone | 2314871020 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Street Address |
2325 SUMMIT PARK DR STE D |
| City | PETOSKEY |
| State | MI |
| Zip Code | 49770-8774 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780231985 | Olivia Michelle Seaman | Pharmacist | 1301 U.S. 31 N. Hwy, Petoskey, MI 49770 | 2019-08-22 |
| 1649733148 | Harbor Hall, Inc. | Clinic/Center | 302 Orchard Ridge Drive, Petoskey, MI 49770 | 2019-04-11 |
| 1053802942 | Devin Hueston | Dentist | 231 State St Ste 3, Petoskey, MI 49770 | 2018-05-25 |
| 1720585037 | Jacob Kenneth Tracy | Counselor | 410 E Lake Street, Suite 100, Petoskey, MI 49770 | 2018-04-12 |
| 1013424191 | Timothy Robert La Gasse | Nurse Practitioner | 401 Connable Ave, Petoskey, MI 49770 | 2018-01-10 |
| 1609303676 | Shauna Sue Stark | Nurse Practitioner | 560 W Mitchell St Ste 505, Petoskey, MI 49770 | 2017-05-22 |
| 1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
| 1457719239 | Hufford Vision & Eye Care, PC | Optometrist | 560 West Mitchell, Suite 214, Petoskey, MI 49770 | 2016-02-08 |
| 1053779439 | Kaylyn Schiemann | Specialist/Technologist | 1980 Maxwell Rd, Petoskey, MI 49770 | 2016-02-01 |
| 1669839130 | Stieber Pediatric Dentistry Pllc | Clinic/Center | 1605 Us 131 Highway, Petoskey, MI 49770 | 2016-01-28 |
| Find all providers in zip 49770 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174507495 | William James Gallo | Dentist | 322 Bay St, Petoskey, MI 49770-2489 | 2005-11-30 |
| 1568456028 | Robert Scott Sheperd | Dentist | 2325 Summit Park Dr, Suite D, Petoskey, MI 49770-8774 | 2005-09-09 |
| 1154483014 | Northern Michigan Oral and Maxillofacial Surgery PC | Dentist | 322 Bay St, Petoskey, MI 49770-2489 | 2006-12-15 |
| 1003892944 | James J Osetek | Dentist | 322 Bay St, Suite 2, Petoskey, MI 49770-2489 | 2005-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568080414 | Shawn J Kim | Dentist | 425 E Washington St Apt 811, Ann Arbor, MI 48104-2060 | 2020-07-08 |
| 1962969634 | Garfield Road Dental - 1 | Dentist | 41781 Garfield Rd, Clinton Township, MI 48038-1964 | 2019-02-28 |
| 1477903904 | Abed Yakan | Dentist | 2700 Martin Luther King Jr. Blvd., 358, Detroit, MI 48208-2576 | 2016-06-15 |
| 1811378508 | Christopher Niquette | Dentist | 2119 64th Street Sw, Byron Center, MI 49315-4931 | 2015-06-18 |
| 1528446069 | Douglas David Orzel | Dentist | 9021 N Rodgers Ct Se Ste A, Caledonia, MI 49316-7650 | 2015-05-17 |
| 1013321165 | Raymond James Hanna | Dentist | 3766 Elder Rd S, West Bloomfield, MI 48324-2534 | 2014-06-17 |
| 1831536861 | Claude Charles Lerose Jr. | Dentist | 20675 Mack Ave, Grosse Pointe Woods, MI 48236 | 2013-05-31 |
| 1821433566 | Curtis Cardon | Dentist | 5957 Harvey St Ste 200, Norton Shores, MI 49444-9737 | 2013-05-08 |
| 1043568694 | Nick Leone Dds PC | Dentist | 28018 Harper Ave., St. Clair Shores, MI 48081-1562 | 2012-08-29 |
| 1770848129 | Bradley Dental | Dentist | 21635 Ryan Rd, Warren, MI 48091-2788 | 2012-07-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.